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PLATINO ALCANCE (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PLATINO ALCANCE (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PLATINO ALCANCE (HMO D-SNP) in 2025, please refer to our full plan details page.
PLATINO ALCANCE (HMO D-SNP) is a HMO D-SNP plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Puerto Rico. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that PLATINO ALCANCE (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
PLATINO ALCANCE (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PLATINO ALCANCE (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For PLATINO ALCANCE (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $80.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3650.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The PLATINO ALCANCE (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, the plan covers your prescription drugs. If you qualify for the low-income subsidy, you will pay no copay for your Part D drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The PLATINO ALCANCE (HMO D-SNP) plan offers a wide range of benefits with no copay for ambulance services, emergency services, and transportation to health-related locations. The plan also includes coverage for primary care, preventive services, hearing, vision, dental, and home health services. Additional benefits include coverage for medical equipment, home infusion services, and dialysis services, along with outpatient services and skilled nursing facility services. Some services, like prescription hearing aids, and dental are subject to an annual maximum. The plan also offers other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. The plan requires prior authorization for Inpatient Hospital-Acute services.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. Outpatient substance abuse services are covered, but individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by PLATINO ALCANCE (HMO D-SNP), but requires prior authorization. The copay and coinsurance for this benefit are not mentioned in the provided information.
Ambulance and Transportation Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers all ambulance services with no copay or coinsurance, but requires prior authorization, and does not cover ground or air ambulance services. Transportation services to any health-related location are covered with no copay or coinsurance, and include 28 one-way trips per year via taxi, rideshare services, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the PLATINO ALCANCE (HMO D-SNP) plan with no copay and no coinsurance, while Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage amount of $75.00.
Primary Care See details
The PLATINO ALCANCE (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services (5 visits per year), Occupational Therapy Services, Physician Specialist Services, Podiatry Services (4 visits per year), Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Individual and group sessions for Mental Health and Psychiatric services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay, Health Education, Alternative Therapies (12 visits), Nutritional/Dietary Benefit (12 visits), Remote Access Technologies, Counseling Services, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual physical exams, In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, and Home and Bathroom Safety Devices and Modifications are not covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids (all types) are covered, with a plan maximum of $1750 per year for both ears combined. Some services are covered, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers vision services, including routine eye exams and other eye exam services, with one exam covered every year. The plan also covers eyewear, with a combined maximum benefit of $500 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers dental services, including Medicare Dental Services, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Implant Services, Prosthodontics, fixed, and Oral and Maxillofacial Surgery. Maxillofacial Prosthetics and Orthodontics are not covered, and there is a maximum plan benefit of $2750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the PLATINO ALCANCE (HMO D-SNP) plan. Insulin and Medicare Part B Insulin Drugs are covered, while Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered with this plan. The plan covers dialysis services.
Medical Equipment See details
Medical Equipment benefits are covered by the PLATINO ALCANCE (HMO D-SNP) plan, but some services are not covered. Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefit have no copay or coinsurance, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are generally covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for covered services.
Home Health Services See details
Home Health Services are covered by the PLATINO ALCANCE (HMO D-SNP) plan with no copay or coinsurance, but require authorization. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PLATINO ALCANCE (HMO D-SNP) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services includes acupuncture and over-the-counter (OTC) items. Acupuncture is covered for 12 treatments per year. Over-the-counter items are covered up to $70 every three months, including nicotine replacement therapy and naloxone.
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